Why the study?
Does the combination of an immunoturbidimetric D-dimer assay and pretest probability score accurately rule out suspected venous thromboembolism in hospital patients?
Does the combination of an immunoturbidimetric D-dimer assay and pretest probability score accurately rule out suspected venous thromboembolism in hospital patients?
A normal immunoturbidimetric D-dimer level combined with a low or intermediate pretest probability score safely rules out venous thromboembolism, potentially avoiding unnecessary confirmatory imaging.
May support VTE rule-out without imaging in hospital patients; leaves open prospective validation before practice change.
Venous thromboembolism is a leading cause of co-morbidity and death in hospital patients. This observational study looks at the usefulness of pretest probability and immunoturbidimetric D-dimer levels for the diagnosis of thromboembolic episodes in outpatients (108 of 197; 54.8%) and inpatients (89 of 197; 45.2%). Across 197 consecutive patients, D-dimers showed 100% sensitivity (95% CI, 87-100%). As a result, the combination of normal D-dimers and low or intermediate probability score yielded a negative predictive value of 100% (95% CI, 90.6-100%). The tests lacked specificity and positive predictive value. Normal D-dimer level in patients with low or intermediate pretest probability makes venous thromboembolism an unlikely diagnosis and may obviate the need for confirmatory scans. All other patients will need diagnostic imaging. Clinicians should be aware of the above utility and limitations while making management decisions for patients with suspected thromboembolism.
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Anoop et al. (2009) studied this question.
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